Lung recruitment

There has been considerable interest in recent years in the concept of lung recruitment. The rationale is that reopening of collapsed alveoli will result in improved gas exchange, with resulting reductions in airway pressures and FIO2. Timing is crucial as collapsed alveoli are more likely to be recruitable in the early stages of respiratory failure.

It appears that benefit is more likely in non-respiratory causes of ARDS, rather than in cases of direct pulmonary pathology such as pneumonia. Some animal studies suggest that recruitment procedures may even be potentially injurious in the latter situation.

Consideration should be given to lung recruitment soon after intuba-tion in patients with severe respiratory failure, and procedures causing de-recruitment, e.g. endotracheal suction and airway disconnection.